1Thoracic Surgeon, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2General Surgeon, Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3Thoracic Surgeon, Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4Medical Student, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84%) and dyspnea (53%). Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%). In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases), and the mean length of hospital stay was 6 days (5-8 days) which was longer (1-2 months) in patients with gangrenous bowel (3 patients). Furthermore, no mortality was reported during the course of hospitalization in these patients. Conclusion: According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients.
Ganie FA, Lone H, Lone GN, Wani ML, Ganie SA. Delayed Presentation of Traumatic Diaphragmatic Hernia: a Diagnosis of Suspicion with Increased Morbidity and Mortality. Trauma Monthly. 2013;18:12.
Chatzoulis G, Papachristos IC, Daliakopoulos SI, Chatzoulis K, Lampridis S, Svarnas G, et al. Septic shock with tension fecothorax as a delayed presentation of a gunshot diaphragmatic rupture. Journal of thoracic disease. 2013;5:195-8.
Hajong R, Baruah A. Post-Traumatic Diaphragmatic Hernia. Indian J Surg. 2012;74:334-5.
DeMuro JP. A Delayed Traumatic Diaphragmatic Hernia Presenting With a Bowel Obstruction 20 Years Postinjury. J Clin Diagn Res. 2013;7:736.
Gierada OS. Imaging of the diaphragm.In G. Alexander Patterson, Joel D.Cooper, Jean Deslauriers, Antoon.M.R.Lerut, James D.Luketich, Thomas W.Rice.Pearsons Thoracic &Esophageal Surgery.Vol.1, 3thed, G. Alexander patterson,Tina Rebane.2008.P..1380-95.
Wadhwa R, Ahmad Z, Kumar M. Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax. Indian J Anaesth. 2014; 58:186.